1. Acupuncture Treatment of Diseases Gastrology 2: Vomiting 呕吐

2. Definition: 1.Commonly seen in clinical, can exist independently of be seen together with other symptoms from many diseases. Involved 2 main symptoms 2.“Ou” is characterized by a loud retching sound without vomit. 3.“Tu” is throwing up silently. 4.Usually occur together. 5.In western medicine, it is seen in acute and chronic gastritis, gastric dilation, cardiospasm, pylorospasm, gastroneurosis, cholecystitis and pancreatitis.

3. Causes and Pathogenesis : 1.Invasion of the stomach by wind, cold, summer-heat, dampness or a filthy, turbid qi attack. Leads to a disharmonized stomach and stomach qi ascending. 2.Over eating of raw, fatty and sweet food or food poisoning. Leads to impairment of the spleen and stomach, food retention and decrease in motility and upward perversion of the stomach qi. 3.Stress and anxiety. Leads to impairment downward movement of the stomach qi and damage spleen transportation. 4.Over-exertion. Leads to hypofunction of the TE, reduces distribution of body fluid, increase phlegm production that accumulate in the stomach.

4. Clinical Manifestations: 1.Excess syndrome Chief symptoms: i.Sudden attack. ii.Profuse, acid and fermented vomitus.

5. Clinical Manifestations: 1.Excess patterns A.Invasion of stomach by cold evil type i.Watery or solid vomit right after a big meal. ii.Loose stools. iii.Preference for warmth and aversion to cold.. iv.Light coloured tongue with white coating. v.Slow pulse.

6. Clinical Manifestations: B.Pathogenic heat collection in the stomach type i.Vomiting acidic, fermented, bitter vomitus just after a meal. ii.Dry mouth and thirst. iii.Preference for coolness and aversion to warmth. iv.Dry and difficult defecation. v.Reddish tongue. vi.Yellow coating vii.Rapid pulse.

7. Clinical Manifestations: C.Phlegm obstruction type i.Watery vomitus accompanied by distended epigastric area. ii.Poor appetite. iii.Light coloured tongue. iv.White and greasy coating v.Slippery pulse.

8. Clinical Manifestations: D.Attack of the stomach by liver qi type i.Vomiting after an onset by some emotional disturbance. ii.Acid regurgitation. iii.Frequent belching. iv.Irritability. v.Thin pale tongue. vi.Thin coating vii.Wiry pulse.

9. Clinical Manifestations: 2.Deficiency syndrome Chief symptoms: i.Intermittent, long term vomiting. ii.Small amount. iii.Less pungent vomitus.

10. Clinical Manifestations: 2.Deficiency syndrome A.Deficiency cold of the spleen and stomach type i.Vomiting just after an inappropriate meal. ii.Weakness. iii.Loss of appetite. iv.Loose stools. v.Sallow complexion. vi.Lassitude. vii.Pale tongue with thin coating. viii.Weak pulse.

11. Treatment : For both Excessive and Deficiency cases. Ease the chest and sooth qi, direct qi downward to ease vomiting and regulate qi dynamics in the stomach and intestine. Principle channels: 1.PC channel. 2.ST channel. 3.Conception Vessel.

12. Principle acupoints: 1.PC 6 Neiguan 内关. 2.ST 36 Zusanli 足三里. 3.CV 12 Zhongwan 中脘.

13. Prescription explanation (Principle acupoint): 1.PC 6 Neiguan 内关 : Luo-Connecting point of the PC channel and one of the Eight Confluent acupoint, chosen to ease the chest and sooth the qi, direct qi downward and stop vomiting. 2.ST 36 Zusanli 足三里 : He-Sea and lower He-Sea acupoint of the ST channel where qi of the channel congregates, chosen to regulate qi dynamics in the stomach and intestines to drive the stomach-qi down. 3.CV17 Zhongwan 中脘. Channel acupoint of the CV channel and Fu Influential acupoint an Front-Mu acupoint of the stomach, chosen to harmonize the stomach and stop vomiting.

14. Principle of treatment Excessive pattern: Invasion of stomach by cold evil type of vomiting: Regulate qi and disperse cold evils. Principle acupoints: as stated Supplementary acupoints: 1.BL 21 Weishu 胃俞. 2.CV 13 Shangwan 上脘.

15. Principle of treatment Excessive pattern: Pathogenic heat collection in the stomach type of vomiting. Regulate qi and disperse heat evils. Principle acupoints: as stated Supplementary acupoints: 1.LI 4 Hegu 合谷.

16. Principle of treatment Excessive pattern: Phlegm obstruction type of vomiting. Regulate qi and dissipate phlegm. Principle acupoints: as stated Supplementary acupoints: 1.CV 17 Tanzhong 檀中. 2.ST40 Fenglong 丰隆. 3.ST 25 Tianshu 天枢.

17. Principle of treatment Excessive pattern: Attack of the stomach by liver qi type of vomiting. Regulate qi and stop vomiting. Principle acupoints: as stated Supplementary acupoints: 1.GB 34 Yanglingquan 阳陵泉. 2.LR 3 Taichong 太冲. 3.SP 4 Gongsun 公孙.

18. Principle of treatment Deficiency syndrome: Deficiency cold of the spleen and stomach type of vomiting: Regulate qi, disperse cold and tonify spleen and stomach. Principle acupoints: as stated Supplementary acupoints: 1.BL 20 Pishu 脾俞. 2.BL 21 Weishu 胃俞．

19. TCM medical advises: 1.Keep warm during time of season change. 2.Avoid exposure to cold and wind. 3.Good diet habit avoiding raw, cold and greasy, fatty and pungent food. 4.Stop smoking and drinking. 5.Avoid emotional and physical stress.